tv Charlie Rose PBS February 4, 2012 12:00am-1:00am PST
>> rose: welcome to our program, we begin this evening with a look at some interesting new developments in understanding alzheimer. we talk to dr. scott small whose's part of the research effort. >> alzheimer describes the disorder in 1906. but 's quite remarkable that for 40, 50,0 years after that there was no talk, no deception about alzheimer. mainly because it was thought to be part of normal aging. so in the 1980 there was a real serious attempt to try to understand this disorder. and the reason why one should be cautiously optimistic is because rational drug discovery, a basic principal of that is that the only way you will really cure a disease is if you understand its fundamental molecular mechanism. and we are only starting to shed light on that in the last 10, 20 years. >> we continue this evening talking to dr. henry kissinger about his recent conversation with vladimir
putin in moskow. >> what putin has been trying to do is to conduct a very assertive foreign policy to put russia on the map again like his model peter the great who brought russia into europe. and so some of his apparent-- is his attempt to give russia an identity. but he has the strategic dilemma that russia isn't strong enough to play that role towards all borders. >> we nclude this evening with dr. david agus, his book is called the end of illness. >> to me cancer say verb, not a known. are you can serg. i want to change you from cancering to healthing. from heart diseases to health. we've been so reductionist in how we treat diseases, we try to basically shrink the cancer and we forget about the system. >> rose: dr. small on new developments in understanding alzheimer,
captioning sponsored by rose communications from our studios in new york city, this is charlie rose. >> rose: major new developments in alzheimer research could have a significant impact on our understanding and treatment of the disease. for the last 25 years researchers have been confounded by this central question, does alzheimer start independently in vulnerable brain regions at different times or does it begin in one region and then spread to connected areas. two new independent studies at colombia and harvard now provide an answer. they indicate the disease can spread from brain cell to brain cell like an infection. dr. scott small of the talk institute for research from
alzheimer disease and aging brain at columbia university medical centre joins me now. he is a co-author of the columbia study. i am please to have him here. we have talked before about the brain series so it is especially pleasing for me to get up this morning and look at the new york times and there is this story, a head of the fold above the fold called path is found for the spread of alzheimer and th's where i would ke to begin. path has been found. tell me, elaborate on what i just said, tell me about this path and what goes in this path. >> all right, well, your introduction was very succinct and accurate. and what people had known from autopsy studies, that alzheimer progresses over time. in other words, imagine three stages of alzheimer, early stage, a patient dies. dow an autopsy. you find it primarily in area a. another patient has moring pro rosive symptoms. he dies. and you see alzheimers in two areas and then in three areas.
and that's always been known for the last 20 years. and the question has always been does area a jump to area b, jump to area c or are they just different areas that are vulnerable and they pop in at different time points. and that's a very difficult question to answer with human patients. and sohat karen duff and i did at columbia and brad highman at harvard, we've used genetic engineering to introduce the pathology of alzheimer in area a in a mouse and then track changes over time. >> rose: that's the pathway. >> and that's the pathway. now the pathway begins in an area called the intraortal cortex, of the hypocampus, important for memory as discussed in some of your brain series so it start notice hypocampus and spreads outside of the hypocampus and that might account for why when we do follow patients with alzheimer, it begins with just very mild forgetfulness, but as the disease progresses, you start havi other symptoms like language
problems, et ceta. >> rose: and how does it go from one cell in one region to another cell in another region? >> well, that's interesting. we don't foe that we have theories. the big news here is that we show that it does. in other words, t wasn't clear that it did. and now that this has been shown, now it really becomes an incredibly interesting question to ask exactly how does that happen. >> and if you find the answer to that, you may very well be able to stop the spread of alz alses. >> that would be the ultimate goal. because then because then alzheimer turns out not to make too many analogies but sort of like the logic for treating cancer, right. cancer spreads over time. >> rose: one cell becomes a multiple cell, one organ and then it spreads to other organs. so the idea is you can detect it in one spot and hit the disease then. you can prevent, it's the easiest way you can imagine in curing alzheimer with these cancers so in an analogous fashion f it really spreads in the way we think, it would be very important to detect it as early as possible ihat
one area and then try to prevent the spread as you described. >> one term that has come up d i want you to expin that is tao what is that and what are the implications that it provides for understanding what is going on. >> okay. so there are fundamentally two hist logic findings or finding you can see under a microscope in a patient with alses alz disease. and interestingly these are two findings that were described by dr. alzheimer himself 160 years ago, am a lloyd plaques and neurofibulary tangles, clumps of protein. in the last 20, 30 years investigators have identify wad is the core element of these abnormallal clumps. in the case of neurofiburlary tangles it is tao and plaques it is abeta peptide so you have these two core elements. so tao is the bake element of neurofebruaryulary tangles. >> rose: and they do well. >> well, they are considered pathological.
tao itself is the normal protein. we all have it, it serves a normal functio and what happens is it starts abnormallally twisting and changing its chemical structure and that causes clumping of proteins. so that is what tao is and that's how it links to neurofibulary tangles, one of the key ftures of alzheimer disease. >> rose: in every study researchers want to say this is what we hope we will find, yet at the same time this is where we caution you not to read too much into this. where is the cautn in this study. >> well, the caution in this study is you know, it's always, the ultimate goal is cure. i mean there is a lot of interesting biology in an ademic centers we can get excited about the intellectual challenges and interpretations. but ultimately there is no question. the quest is cure. anso whenever we have a finding like this which does have potential curative or
clinical implications, the caution is that we're not quite there. >> and you got there by the experiments that were done on mice. >> that's right. >> rose: and tell me about those. >> so these are mice. and in mice what you can do is you can express, it's the one thing i should say to explain this is that every area of the brain has different proteins that are expressed. we have around 25,000 genes. if i look at one area of any of our brains it will just have a certain amount of those genes expressed. and what that means is you could use that molecular ological observation to take any gene you want and using genetic engineering, and of course it would take me awhile really explain it, but to insert it into a part of the genome such that it is expressed in only wound part of thbrain, and that's really quite remarkable, on to itself. and that's lead to great scoveries in how the brain works normally, eric can dell, as you know and other vos shown that if you interfere with a proin in one part of the hypocampus
yomight get memory loss. so in this case what we did and the group at harvard did is used genetic engineering to express this abnormallal tao in the inntra-- in the area where we know alzheimer begins. >> rose: this is the second area of the piece whh we read this morning, but you had suggested to me, before today, that i should look at. the surprising finding answers a long-standing question as immediate implication for developing treatments. researchers said and they suspect that other deagain rattive brain disease-- diseases like park insons may spread in a similar way. tell me about that. >> that is emerging as a very interesting theme. u know, all these neurodeagain rattive disease including things like alzheimer and parkinson and even lou gehrig or als are diseases that seem to start in one part of the nervous system or brain and over time they seem to spread to other areas. so for all these disorders. >> rose: they may have the same spread process. >> the question is do they spread in this way that area
a draw area b may be different parts of the brain, different proteins but if spreading is a unifying theme then that will open up novell therapeutic intervention because as you eluded to a potential therapeutic avenue would be to prevent the spread. >> rose: what is a potential way of depresenting the spread. >> basically there are two ways. if you think about howt spreads, we have two cells, abnormallal protein starts here. it's released outside the cell and it is picked up by e secretary cell so there are twways in which you can imagine doing that in a very, very general sense. you can prevent the first cell from releasing the bad stuff in this case tao or ou can prevent cell b from picking it up from absorbing it. >> rose: right. >> and those are the two kind. >> rose: so either you stop it when it is released or stop it from absorption. >> exactly. >> rose: and how might dow that. >> there are a number of ways if in which you can start doing. it has to do with how do cells pick up things. you know, cells do have cell membranes but they are pore oust there is what is called
active absorption. they need to take nutrients so we can actually rely on what we know about the internalization of stuff from outside ot cell to try to develop drugs that might block the uptake of bad things like tao. >> that is actually not a new idea. the idea of blocking the cells absorption process, you know, has been part of an avenue of hope for being able to treat cancer. >> yes. >> for a while. >> that's right. >> and these are all the cell biology here is true from nearons to every cell in the body. so that's why there is a certain degree of excitement here because we can perhaps piggie back on thnologies that have been developed for other disorders. but now we would focus on the spread of tao instead of spread of cancer cells. >> okay. now there are people who will look at this in the sound of my voice, and your ice, and say when from my father, when can i expect th to happen because my
father has been diagnosed with alzheimer and i want to kn. >> so as i think you know, i am a very direct person. i hate waffling. >> right. >> i am not going to waffle but i'm going to tell you is very difficult to really prognosticate. i think some of the trouble we as the biomedical science field have gotten into is making these five year prognostications. >> rose: i mean just say it is years off. >> i would say within-- within years and but what i do want to convey is cautious optimism. i mean generally when i first started seeing patients ten years ago or so, i was pessimistic. there was all this sort of hoop la and it just didn't seem like we were even on the right track. the reason why we should be cautiously optistic is because we're now getting at the fundamental mechanism and that is always a reason to engender optimism. when does it actuay happen that we have that cure, it's very, very hard to predict. >> rose: people like me ask questions like this.
why did this take so long? to answer this question. >> so one of my m culpas to my patients or their families, when i make the diagnosis of alzheim and when i have to admit that they're really not quite there yet in terms of effective cure is remindi everyone that an earnest investigation into the fundamental mechanisms of alzheimer really just began in the 1980s. alzheimer describes his disorder in 1906 but it's quite remarkable tt for 40, 50, 60 years after that, there was no talk, no discussion about alzheimer. mainly because it was thought to be part of normal aging. so in the 1980s it was a real serious attempt to try to understand this disorder. and the reason why one should be cautiously optimistic is because rational drug discovery, a basic principal of that is that the only way you're really going cure a disease is if you undstand its fundamental molecular
mechanism. and we're only starting to shed light on that i would say in the last 10, 20 years. >>ose: so that's really the breakthrough understanding the fundamental molecular mechanisms. >> that's right. and that's taking some time. >> rose: but that's where hope can really enlarge this notion, if you get that molecular mechanism you will understand not only bo alzheimer but a lot of other things. >> or am i way off there. >> when you say other things. >> rose: other deagain raive diseases as you have suggested. >> that's right, that's right there are unifying themes in all deagain rattive issues, the issue of spread is extremely interesting. >> rose: speak to that more. >> so like we already discussed, a cell naturally has to absorb things from the outside, we call that extra cellular space, it naturally has to he is cret thing that is the way it is built. if he understand the cell biology of that how do cells absorb and secrete, then we can maybe start seeing patterns across all near ro deagain rattive diseases
that have the same faulty mechanisms of maybe too much he is connection and the difference between parkinson's and alzheimer might be the same kind of abnormallal secretion-- he is connection mechanisms but different proteins, different pathogenic peptides are released so that's where there might be some emerging themes across different now deagain rattive diseases. >> rose: let's make this biographical to you. >> ous. >> rose: you went into medicine for what reason? >> i went into medicine to actually understand how the brain works. which is probably not what i said in my medical school interviews. >> rose: you probably said want to treat patients, i have a passion. >> i have a passion, i really, and that wasn't completely-- . >> rose: but when you entered medical school from underiad gate to medical school you understood that what a passion was, was understanding how the brain works, that whole field of neuroscience. >> that's right. >> rose: was this then to focus on row search, is that where you thought you were heading. >> i did think i was heading there.
in fact, i started in the md ph.d program with eric kandel. i never finished the ph.d part but it was very much an academic endeavor for me. >> rose: but then you itched to thinking that you wanted to deal with patients. and fact you wanted to be somehow a clinical physician. >> actually, that's true. that did partly happen. like i said, i might have blufd a little bit in my interviews but then-- . >> rose: but you came back to it. >> then once i was in the clinics, discovered that i actually really, really enjoyed it. >> rose: the patient stuff. >> the patient stuff, just being with patients,it's a completely different source of satisfaction. and it could be frustrating, you know, right now i still see patients half day a week. and i don't really have to. most of my salary comes from funded grants, i do mainly research but i would never stop seeing patients because it really is something very different t keeps me grounded. it keeps my science focused on the important questions. >> rose: tell me about the joy of medical researchthe act of discovering. >> it is incredibly joyous
moments in time are joyous. an when those moments happen they are wonderful. and they counterveil the hours and days and months of frustration. and it's strange how we sort of live for those moments. and there is a sense of okay, i'm going toget there and you know week in, week out it doesn't work. and suddenly it works. and it is such a joyous feeling. and i think it's wonderful. i think boio medical research say wonderful field there is a lot of hand-wringing now about medicine in the united states and being a practitioner but i think biomedical science, you know, in the 21st century is a fantastic field. >> but is the thought that people like you have, it is unraveling the mystery, the mystery rather than what i am trying to do here save millions of lives. >> it's both. probably the most noble answer is that i'm in this only to save lives. and i partly am. and you know, i've spoke
tone friends and family and what is clearly going to give me most joy at the end of my life is if i cure disease more than understanding a mechanism. however at the same time, there is something so elegant about making-- generating a hypothesis about how something might work, slogging through the experiments having a postop present with you a data and you think wow that is just beautiful. so there is a certain aesthetics of discovery that is just beautiful unto itself. so it's both i would say. >> thank you for coming. >> thank you. dr. henry kissinger-- kissinger is re, he recently visited moskow where he met with russian prime minister vladimir putin. russia has also been central in the debate over soiria in the united nations this week, resisting a proposal by western and arab countries calling for president assad to step down. i'm pleased to have him back at the table to talk about the kinds of things that he spends his life focus on.
welcom. >> thank you. >> rose: you go to moscow and do what no one else rarely does, you sit down with a long conversation with mr. putin who is moving from being prime minister to the presidency, we assume. >> whs's on his mind? >> will, i think he's facing an unexpected situation he announced-- he announced in october that he would run for the presidency and that the current president would then become his prime minister. >> rose: medvedev. >> medvedev, reversing what was done four years earlier. and it was assumed that this was a very normal trsfer of power reflecting putin's strengths. so then they had parliamentary elections in early december. and which were conducted more or less the way other poorlymenty elections had
been conducted with some influence by the government and some cooking of the vote. but it then appeared that the middle class which had been largely created as a result of putin's previous efforts protested and was totally unexpected. so there were big demonstrations in moskow and smaller ones in othe cities. that objected to the lack of transparency of the system. >> rose: they thought the elections were in some cases fraudulent. >> yes. and ey had pictures of ballots being stuffed. so this ha created a new situation. because the transfer of power which was expected to be smooth and the assertion of putin's predominance by was taken as given, it's now
being challenged. and that is a new development and a middle class revolution has never happened in russia. and it isn't yet a revolution. and it may never become a revolution. but it will affect the nature of the system. and will require some changes in governmental procedures. >> rose: meaning what, what kind of changes? no one doubts that he will be elected president, do they? or is th in question. >> i met nobody who doubted it. everybody i met thought he would-- would win by 53% the figure that most people gave. however t is possible if he doesn't get over 50%, he has to have a runoff. that already would be a huge change in the system and the kind of setback for him.
>> and be erosion of his authority. >> and an erosion of his authority. but it's almost-- but it is assumed that he gets 53% which at least everybody i talked to seem to expect. then he has to form a government. and he appoints a prime minister, he has already announced that he would make medvedev the prime minister. but theoretically the prime minister has to get approval of the duma. now the duma is the result of that election that it is so ctested. >> rose: the duma being the russian parliament. >> but i expect that the parliament, however it was elected, is going to be more assertive now than it was in the previous period. >> rose: so putin will be less powerful? >> he will be, yeah, probably more constricted. >> rose: whaes his view of russia's future and russia's role in the wor looki at
the circumstances followg rab spring, looki at the rise of china and asia, looking at the turkey, playing an important role in the world today? >> well, i don't want to keep the impression that we sat down and reviewed every last aspect. but over the last ten years i have met him twice a year for long long conversations. so my answer will be sort of a composite. >> rose: but understand that my question comes from this observation of mine. you can tell something about what a person is thinking about, what they worry about, by the questions they ask. >> right. i would say that putin is very conscious of a dilemma of russia that he has tried to resolve one way and the dilemma is this. russia was a vast empire. and was one of the dominant countries in the world, in
the soviet period. and before. as a result of the collapse of the soviet union, the disintegration of the satellite orbit in eastern europe, russia is about back territory release of the europe at the borders from which it started 300 years ago. so how to-- and it faces, in addition, two new situations. in asia it has a 3,000 mile border with china in which in the six province at long the chinese side, there are 100 million people. in the six province on the russian side there are five million people. in all of siberia there may be 30 million people, and in china there are a billion and a half people. so this disproportion in
demmography, in order to industrialize ciber ya, they have great trouble getting russians to move to siberia. you would, if the world were truly globalized you would permit asian immigrants. but the chinese, the russians are afraid of the chinese immigrant would never leave. because much of this territory was taken from china. so they have this border which is a strategic nightmare. then they have the islamic border, another 2,000 miles, which is an ideaological nightmare. they have over 20 million muslims on their side ofhe border. and the muslim world in turmoil and with radical trends and other trends. and then they have a border to the west which is a
historical nightmare in the sense that they haven't seen that for 300 years. so what putin has been trying to do is to conduct a very assertive foreign policy to put russia on the map again like his model peter the great who brought russia into europe and so some of his apparent blusterings is his attempt to give russia an identity. but he has a strategic dilemma that russia isn't strong enough to play that role towards all borders. so when you say what does he think about the-- . >> rose: circumstances of 20123. >> what does he think, for the arab spring, what i believe is we russians hav trouble enough with-- now
mes this radical democratical populist movement and what if it spreads across our border. and so they look at syria and thinks that we read in our newspapers, not from the point of view of what progress is made in those countriesment but from the point, from two points of view. one what does this do to the trend or belief of populist movement. and at will our muslims demand our mushan muslims demand as a result of all this. and second, they're afraid that it will be yet another demonstration that russia does not play the role in international affairs, to ich he thinks is entitled. >> rose: okay, let's look at the u.n.. i interviewed the prime minister of qatar who is a central figure in terms of
say one of the people here because he has become up front in termsf what the arab world response ought to be. and the one country that stands in the way of doing more at the united nations is russia. why is russia, you know, defending someone w is bein criticized by the rest of the world for shooting their own citizens? >> they feel that ty were in a way deceived in the libyan resolutions, that ey agreed to a resolution on libya to protect the people against qaddi actis. and this was used as a means to overthrow qaddafi. >> rose: they believe it was to be a defensive measure to save the citizens of benghazi not an offensive measure. >> when u talk about it or any other leader, they do not want u.n. past resolutions about what they
consider a domestic structure of a country. and they believe or at least some people when i was in russia argued that the situation in syria is going to become chaotic, that all these various groups are going to wind up not in a nice civilian arranged government but as a kind of a civil war between factions. that's their perception of it. >> rose: is that your perception? >> well, my perception is also, my perception is that first of all at this point there is no alternative to the change of government in syria. >> rose: there has to be a changen government. >> that a change of government is now inevitable. i however have my own doubts
that it is possible to negotiate an outcome agreeable to all sides. it should be attempted. and i have no better alternative except to attempt it. but if you asked me for my prediction of what is likely to happe, i think there is a great danger that syria will be in turmoil for a substantial period of time. >> is there anything that the united states or the west or russia can do about that? >> other than -- >> probably not. >> rose: probably not. >> well, not every problem of the world has a short-term solution. and once you know, in the 19th century somody once said once a play is started, it will be completed either
by the actors or by the audience who mount the states so this is a play that has started, and the evolution of revolutions is very difficult to control. >> rose: so let me ask you this: make the case for in libya. was the west, france, britain, the united states, right to do what they did which hasteened, come down on the side of the opposition to the government, supplying them with air power, not so much truce and leading to the overthrow of a man like ddafi? was that the wrong policy? >> did it violate principleses that you believe in. >> i had my-- i have grave doubts about the policy.
and for the following reasons. qaddafi was bizarre, engaged in a number of acts that were unforgivable. but he at in stage of his evolution had maintained tolerable relations with the west. i am worried about his situation in which there is no central government left in libya. and in which you have large oil-- and which the west will be put into the position of nation building in society that hast been a nation. again, it's one of those things that once the process started, it had to be brought to a conclusion. and once we have made the
initial decision to go as far as wead, i think it was correct to encourage going the rest of the way. but i do not believe we will celebrate the outcome of the libyan revolution five years from now. >> rose: what will we do five years from now? look back and say -- >> a lot depends on what happened in egypt and in syria, and in the whole evolution of the arab spring. but so to some extent it can be, it can be brought under some control. but i am very uneasy about a cotry in which militant groups occupying parts of each country which it rt of is a sum ali condition, and which could become a center of-- let me make
clear where we are now, we have no chce except to proceed. and where we started, i can understand the concern to prevent a massacre in benghazi. but we have to learn or understand that when the revolution rarely end the way their organizers proclaimed them. and once you start that process or get heavily involved in that process, it has its own momentum. >> rose: but can't you argue that stability and the status quo is not always in the best interest of the long term. >> absolutely. which would agree with that. >> rose: and that is the reality perhaps of the arab
spring? >> i don't think it was possibly or perhaps even desirable to avoid the outbreak of the arab spring. but the evolution of the arab spring i have had my doubts about the he lack rit in which mubarak was dumped. >> but that has to do he had been a long time friend of the united states and you thought his case should have been handled better because of friendship. >> i thought that we did not owe him keeping him in office. that was beyond us. but we owed him a dignified depar ture >> rose: how do you know we didn't offer him that and he wodn't take it. >> i'm not saying-- i don't ink-- i think we acted rather quickly. but so i look the evolution of these revolutions, and you have to lo at the forces that they
generate and how they can come together, the essence of a revolution is that a confluence of resentments. and these resentments can sweep away the existing structure. the second phase of a revolution then is to distill out of this bundle of resentment an organizing group that can restore enough authority so that you can conduct long-range policy. and that then becomes very difficult problem. and if it doesn't go well, that isn't our fault. and that doesn't mean we could have avoided it. but we ought to understand it. >> rose: my argument is simply that i lieve that whatever happens in terms of islamist politics and islamist parties gaining some degree of power to the lesser or more, that is an
inevitab evolution that has to take place. and you can't stand in the way of that evolution. you have to be mpetitive and you have to be engaged but you can't simply stop that process. >> you know people who say i told you so are usually pretty boring. but remember the first week of the revolution i-- . >> rose: you told so. >> i told you so. no, we cannot stophe fact that the islamists are gaining-- . >> rose: right. >> in these elections. >> re: right. >> but we need to understand that this cannot therefore necessarily be described as a democratic outcome. >> rose: much was made of the obama administration's reset of the relationship with russia. has it been reset. are the russians happy with the reset? >> no, i agreed with the reset. we were in a position of
having talked about ukraine and georgia getting into nato and getting into a posture of potential at least verbal confrontation with russia. >> rose: because the russians view it as a threat to them and too close to their borders. >> too close to their borders. and also ukraine had been part of russia for 300 years. and for it to be independent was a painful enough, to then become part of nato 400 miles from moskow, that was a big dision to swallow. so the obama administration, decision to get into a dialogue with russia and then to come to an agreement on the limitations of warheads inside of a strategic agreement, which
in a way really renewed what bush had already done, the numbers were a little different, but not substantially different. i support them. and i testified for-- on os behalf. then the relationship hasn't gotten worse so much as that it has languished. that each country had so many other preoccupations in the last two years that the relationship now isn't bad. but it needs a new definition because when conditions have anged so much. >> rose: do they have an inferiority complex now or not? >> because of what they've gone through, empires lost. >> they have a great instct of perhaps not being taken seriously enough. but at the same time when you meet people outside the
ol i gart, people without are really engaged inside a global economy, they now for the first time in russian history are really engaged in the global enomy to a large extent. >> rose: indeed. >> in an integral manner. and that requires for them some adjustment of their historic somhat isolationist secluded. >> rose: some would rring argue they need to be because th need to somehow move away from their dependence on their energy as the principal revenue source for their economy. >> absolutely. >> rose: as long as they are dependent on that, those prices go up and down depending on supply and demand. >> economically in a way they behalf like saabee arabia. and they don't behave like a great industrial country to diversify. >> or behave the way israel
has in terms of about being an extraordinary welcoming, the technology community and becoming a real force. >> but they are actually trying to do that. they are creating a kind of silicon-- silicon valley. >> medvedev went to silicon valley to see what he could learn because he wanted to take it back to moskow and build his own, as you say. thank you for coming. >> always a pleasure to be here. >> my pleasure. dr. david agus is here, an oncologist and professor of medicine and engineering at the university of southern california. his new book, the end ofimness challenges some of our long-held beliefs about what health means. i'm pleased to have him here to talk about having him back to talk about his book. walter isaacson who wrote the book on steve jobs said in this brilliant book david agus introduced a new way of looking at agus and taking a queue from nixes viewed the body as a complex stem and helps to see how cancer to nutrition fits into one whole picture. the result is a useful guide on how to stay healthy and
fascinate analysis of the latest in medical science. boy, that is pretty good, huh? >> it's great. we're very proud. >> rose: so first the title, the end of illness. there is this story that the title was going to be something else that had health. >> right. >> rose: in the title, and steve jobs who you came to know and a docto patient relationship and a friend. >> uh-huh. >> rose: said don't do that. >> yeah. steve had sent me this e-mail said when you put health in the title is akin to chewing cardboard or brussel sprouts. and people wl automatically turn off. so the end of ill sense a declaratory aggressive title so tif was much more excited about that we could be much more, get our message across and change things from this kind of title. >> rose: talk about him for a moment. >> sure. >> rose: because walter makes a point in the book. >> yes. >> rose: that he had fragmented care. >> uh-huh. >> rose: lots of different doctors doing different thin. and in an understandable obsessive search to find a cure to his cancer. >> uh-h. >> rose: and tone joy a longer life. >> uh-huh. >> rose: that's not a good idea. >> no, i mean with any kind
of care you need a quarterback. you need to have one person you trust. you can certainly get be opinions from different places, use technology from all over but you need a quarterback. you have to put your faith in your doctor. if you don't, find a different doctor. >> rose: so he should have found a quarterback. >> i am not sure how fregmented his care was. i mean his care was centralized in northern california, at standford. we werenvolved in a peripheral way and honored to be. but his care was pretty remarkable. he lived for many years with metastatic disease. >> rose: so who is the lesson that comes out of steve jobs battle with cancer. >> you know, the lesson is prevention. you know, i look at people every week in the eye and they say i have no more drugs to give you. are you going to unfortunately cancer is going to win. the key is preventing cancer. and so i truly believe we can delay illness until our 9th or 10th decade through relatively simple strategies but prevent cancer is the way to go. >> ros is this simply the basic ideas we all are familiar with. nutrition, don't smoke, don't do all the things that
contribute to deagain rattive diseases. >> that's certainly part of of it. but you know inflammation is at the core of heart disease, cancer, neurodeagain raive diseaslike alzheimer. and there are clear mechanisms to delay or prevent inflammation so things as simple as wearing good shoes. you walk around the hse bare fool, it's a lot of pleasure on your joints that adds up. >> rose: so you shouldn't walk around barefoot. >> no, wear slippers with cushons t is less measure on your joints. >> rose: what is inflammation. >> inflammation is you know it when you nick your finger and it turns red it is your body's attempt to rid thed aboutee of something. inflammatory cells, the immune cells come in, and they create free radical its and damage tissue. over time that builds up and that leads to diseatses like heart disease and cancer. you want to head that off at the pass. another simple way to do it, is regularity in schedule. is so eat your meals the same time every day. you have your lunch today at noon and tomorrow at 2:00. >> rose: for two hours stress hormones go up that is a lot of stress on the body. >> rose: what else. tell me what else i should know to be on the side of
the d of illness. >> so the technology, so to me technology is at the core of many of these. now dna technology is rampant. it's a mature technology. but dna technology is your ingredient list. it's akin to done hillis one of the great technologists told me a story and is said if you stand in front of two chinese restaurant its and look at the ingredients, they are the same. you taste the food is you different, the next is protiomics. so it is all prot teens in the blood. so plotieom o ask the study of proteins. and it is a 60 gigabyte picture of the proteins of the blood. a picture of you one moment in tim we look at one factor. we look at your vitamin d level, we look at your sodium level and we try to fix it we never look at the whole syem that is one of the big failures of medicine is trying to correct those. >> rose: where are we in the process of understanding or the forward strides we hope would come from genetic
therapy. >> i think we are early. it's very early days. certainly genetics and cancer, you know, steve made an amazing analogy in walter's book we are said it was like jumping from lilly pad to lilly pad going on a molecular target of therapies. so certainly now with many cancers we can identify an achilles heel and target it. but i will give you a countercase. in breast cancer there is an amazing study done in austria where they basically after optimal therapy for breast cancer, half got a drug that builds bone and half got placebo. and they reduced recurrence of the breast cancer by over 40%. so you change the soil which is where breast cancer metastasizes the seed doesn't grow. sot changed the system, so cancer couldn't happen. because to me i know this is a weird statement, but to me cancer is a verb, not a knn. are you can serg. i want to change you from can serg to healthing. from heart diseases to health. and we've been so reductionist in howe treat diseases, we try to basically shrink the cancer
and we forget about the system. >> rose: is canc of the lungs, breast cancer, lung cancer, prostate cancer, is it all the same in a sense on a moll eck har me tas that sidesing. >> there are certainties. so the notion of calling cancer by body part came from the 1800th in france. it is somewhat archaic. but what is amazing to me and really shocks me that if i showed a pathologist he or she under the microscope colon cancer they would look and say colon, prostate they would say prostate cancer. they don't care what the genes are. and the body doesn't care. they care what it looks like. sokol on cancer there are 50 different genetic ways to get there. but evolutionists select it for what it looks like. >> rose: but let me make a test, suppose a doctor would come in who had not, knew nothing about the patient, knew nothing about what the patient was suffering from, and me in and you showed him or her a slide. and said this a cancer slide.
this is a cancerous cell. could they identify what kind of cancer it was. >> much of the time. most of the time they could. >> rose: they would say i knows prostate cancer. >> becauset los a certain way an has certain markers on it, yes. and so again it's the februaryo type t is at it looked like. >> rose: suppose a cancer had spread from the lymph nodes to the brain, when it got to the bin it would look different. >> no, it still looks like where it came from. it still looks like where it came from. for some reason it is looking a certain way and it's wild in that regard. and we keep trying to treat the underlying genes. the average cancer on diagnosis has about 120, 130 mutations. how do you model that? how do you target that. we have to think of cancer differently. >> rose: is that the problem. >> that's the fundamental problem. it's too complex. >> rose: too many pathways. >> galileo will go out and map all the stars in the sky and after four months could tell you where every star could be. he didt know what a star was. we keep trying to understand. our job is to control. we have to think like an engineer. we have to think like a
danny hillis, more like a biologist. >> rose: and if we did we would understand what? >> we would start to opted my on control. because we need to again we're complex emergence systems almost impossible to understand. but you can control them. and so we need to start to building in systems to control. where we need to do something, see its response and do it again. >> rose: how far along are we in beginning that kind of medicine? >> my hope is we're not that far away. >> really. >> my hope is this happens over the next three to five years. >> its technology is there, it is just the cull tear. >> yeah, i mean the technology is definitely there. and we're getting new technology and new dimensions to helpe health get aid load of this. there are tenfold more back ter why in the body than cells in the body. those bacteria control how you met an lyze your food, your hormone levels so for e first time now we starting to quantify thor bacteria and qualify them and look at the differences in bacteria. if someone from china moves to the uted states, their rate of certain cancers goes up dramatically. and it's the microbuy om, thbacteria that are doing this.
>> some people including some famous scientists have been obsessed by vitamin c. >> yeah. >> were they right? >> you know o 1746 james lynn writes a treatise on scurvy, captain in the british royal navy and beats the french. because they had limes on their french and didn't get scurvy. he publishes a book and says i sell the extract of lime. in the early 1800s we still call it infectious disease because as soon as you squeeze the limes the vitamic is not there. >> all a vitamin is something a body cannot synthesize. if you start to look at the sudden studies if a man takes vitamin e his risk of prostate cancer is 17% elevated after three years. >> if he does what. >> takes vitamin e every day. >> why would he take vitamin e. >> the government did a study, looked for 245 million dolls saying does vitamin e prevent prostate
cancer. what do u know, taking it every day for three years increases your risk by 17% so why do you take testify ree day, because a multivitamin has it in it. men took it because they thought it would be preventive. and anti-oxidant thought it was good. 17% increase in the most common nonskin cancer on men that is pround on individual and society. >> you see these information advertisements where you take prescription drugs from different doctors. i mean, and its danger of being prescribed drugs that one doctor doesn't know the other doctor has prescribed. and the one doctor doesn't ask you exactly what you are taking, there is danger from that. >> no question about it. no question about it. one of the first things in the k457 ter of the book is a questionnaire to print out before you go to your dock toferment i want you to write all the information down out about you, and then bring to your doctor. bring in everything about you so your doctor knows. and then go even further and store every test, every scan in a cloud. so it's accessible.
what happens is you know, you are on vacation in europe is when you get sick. so you don't have access to your ekg, your cat scan. if it's in the cloud you can have access anywhere and i can't tell you how many lives can be saved if you had your informaon. >> i can't tell you because hi hrt surgery there paris, i can't tell you how many people traveling to france have said to me could i have the name of your doctor st in case. >> yeah. >> well, think if you had all your information. we would know exactly everything aboutou before hopefully we don't need to do surgery in the future. >> rose: what has been the greatest discover in medicine sin penicillin. >> you know t is a great question certainly dna is a part of it you know but dna is one of the few things in biology we got right so we put it on a pedestal. we predicted it a structure, we predicted-- we could do the genome, et cetera. anti-buy ot oiks i'm not sure it is the greatest discovery because it kind of screwed us up a little bit. we started to treat all disease like infectious disease so infectious disease you make the diagnosis, you have the treatment. but if i diagnose you with cancer, i don't know the
treatment. infectious disease is from without. other diseases are from within. so we can't treat everything like infectious disease. we have to treat themery differently. >> also the phenomenon that cancer cells for example develop an immunit ot certain kinds of treatment. >> yeah, they mew tate ov time. it's evolution in front of your eyes. literally people talk about evolution with darwin over century. i watch evolution happen before me as i give a drug and the cancer mutates and changes. >> so what is your ambitn. >> my ambition really is to ange health care. a current administration, other administrations always talk about health-care reform. but it's health care finance reform. i want real health-care reform. michael dell says it's okay to smoke at dell but you got to have different charges for healthare whether you smoke or you don't smoke. want to start bring in cull paint. i want to prevent disease. i nt to start t say listen, we need a culture of prevention or else we're going to be in trouble. social networks, twitter and facebook can bring down governments in a short time scale. i want to use twitter and facebook to boycott stores
from selling tobacco. i want to do it to demand an end to illness, campaigns to really demand. we have to stop this this new generation, if you have to buy a gm car, 2200 of that price of the car is health care. we need to change things. >> the book is called the end of illness. david agus, md. thank you. >> thank you, charlie. captioningponsored by rose communications captioned by media access group at wgbh access.wgbh.org